HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TORE ACCEPTED
Date:
Permit Number: / go 2. 5w)
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Building PerppF9cation
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential X
PERMIT APPLICATION FOR: Renovation P1 ill
Legal Description:
Property Tax ID#:qt_22c)-(OOa-d1 C)C`Q—( p Lot No.
Site Plan
Project Name: V
Setbacks Front Back:
Right Side: Left Side:
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e errormea unaertms permit - a
� ��Gas Tank ❑Gas Piping
1 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ %DD00
Block No.
Shutters ❑ Windows/Doors
Generator g Roof
Sq. Ft. of First Floor: _
Utilities:Sewer Septic
Building Height:
Roof pitch
AM
Name
Name: Justin Thiery
DC OrV-\ lrA11nLil
Company: Island Kitchen and Bath
_Address: TES _
State:
Zip Coder Fax:
Phone No. 3a-( o - o n�i
Address: 10875 S. Ocean Drive
City: Jensen Beach State:FL
Zip Code: 34957 Fax:
Phone No. 772-237-7348 772-678-8219
E-Mail: 1r) 1(-A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: jthieryikb@gmail.com, nblaszkaikb@gmail.com
State or County License: CBC1259508
IT Value of construction Is,1Z9aD or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name: msdn Th1Bry
Address:
Address:
City: State:
City: Jensen Beech
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address: 1W75 S. 0-an once
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing; work or recording vour Notice of Commencement.
`-;v - % QLy,--X,
Signature of Ownkrl lessee/Contractor as Agent for Owner
Si at C ractor/License Holder
STATE OF FLORIDA .
STATE OF FLDA
COUNTY OF a1 I ��-�
COUNTY OF M U ,i ,tom
The forgping instru ent was acknowledged before me
this By A Ah^ w . 20M by
day o�,
The forgoing instru ent was acknowledg�efore me
this for
of vt c n, a . 201 by
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WOO
LLUNv�/\ OO
i l%�wV1 �Vll fi✓�j
Name f per o making statement
Name of pe7l making statem nt
Personally Known OR Produced Identificatior��
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature;ofNotary ic- a of Florida)
(Signature of Notaic- Sta Ivd )°kICHAELSp{lYF
Olfo*Seal MICIHMLRN
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�fY CAMCommissioo.
Commi n gal EXPIRES: July28.2
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July28,2919__
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED6
Rev.8/2/17